| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
10,200 |
8,873 |
$120K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,132 |
2,036 |
$34K |
| H1000 |
Prenatal care, at-risk assessment |
1,911 |
1,841 |
$28K |
| 96127 |
|
1,446 |
1,172 |
$22K |
| 92551 |
|
1,041 |
1,017 |
$16K |
| 90670 |
|
574 |
542 |
$14K |
| 90686 |
|
932 |
790 |
$14K |
| 90734 |
|
829 |
794 |
$13K |
| 90715 |
|
968 |
864 |
$13K |
| D1120 |
Prophylaxis - child |
304 |
301 |
$12K |
| 90651 |
|
379 |
345 |
$12K |
| 90619 |
|
665 |
564 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
323 |
320 |
$9K |
| D1206 |
Topical application of fluoride varnish |
308 |
305 |
$8K |
| 90677 |
|
89 |
75 |
$7K |
| 90671 |
|
63 |
42 |
$6K |
| 36416 |
|
1,372 |
1,258 |
$5K |
| 99173 |
|
733 |
705 |
$5K |
| 90647 |
|
523 |
441 |
$5K |
| 90723 |
|
401 |
338 |
$4K |
| D1351 |
Sealant - per tooth |
45 |
39 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
105 |
104 |
$3K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
173 |
165 |
$2K |
| 90716 |
|
57 |
41 |
$2K |
| 90633 |
|
269 |
245 |
$2K |
| 90710 |
|
259 |
223 |
$2K |
| 90707 |
|
70 |
55 |
$2K |
| 90696 |
|
199 |
172 |
$2K |
| 99381 |
|
25 |
25 |
$803.75 |
| 90700 |
|
44 |
25 |
$683.56 |
| 90680 |
|
89 |
79 |
$626.95 |
| 85018 |
|
125 |
114 |
$290.00 |
| 90713 |
|
12 |
12 |
$200.52 |
| D0601 |
|
99 |
99 |
$0.00 |
| D0602 |
|
147 |
146 |
$0.00 |